Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Initially, patient portals were rolled out to give patients access to their core medical information, with the hope that a more educated patient would be more likely to take care of their health. Over time, features like appointment setting and the ability to direct-email providers were added, with some backers predicting that they would make practices more efficient. And since providers began rolling out nifty new interactive portals, anecdotes have piled up suggesting that they are delivering the goods.

However, a new study suggests that this might not be the case — or at least not always. The researchers behind the study, published in the Journal of the American Board of Family Medicine, had predicted that when patients got access to a full-featured portal, clinic staffers’ workload would be cut. But they did not achieve the results they had expected.

The researchers, who were from the Oregon Health & Science University in Portland, compared portal adoption rates and the number of telephone calls received at four clinics affiliated with a university hospital between February and June 2014.

They found that despite growing adoption rates of the portal at all four clinics, call volumes actually increased at two of the clinics, which included a commercial, community-based health center and a university-based health center. Meanwhile, call volume stayed level at the two other clinics, a rural health center and a federally-qualified health center. In other words, in no case did the volume of phone calls fall.

The researchers attempted to explain the results by noting that it might take a longer time than the study embraced for the clinics to see portals reduce their workload. Also, they suggested that while the portal didn’t seem to reduce calls, it might be offering less-concrete benefits such as increased patient satisfaction.

What’s more, they said, the study results might have been impacted by the fact that all four clinics were implementing a patient centered medical home model. They seemed to think that PCMH requirements for care coordination and quality improvement initiatives for chronic illness, routine screenings and vaccinations might have increased the complexity of the patients’ needs and encouraged them to phone in for help.

As I have noted previously, patients seldom see your portal the way you do. In that previous article, I described my largely positive — but still somewhat vexing – experience using the Epic MyChart portal as a patient. In that case, while I could access all of the data held within the health system behind the EMR pretty easily, getting the health system employees to integrate outside data was a hassle and a half.

In the case described in the study, it sounds like the portal may not have been designed with patient workflow in mind. With the practices rolling out a patient-centered medical home model, the portal would have to support patients in activities that went well beyond standard appointment setting and even email exchanges with clinicians. And presumably, it didn’t.

Bottom line, I think it’s good that this research has led to questions about whether portals actually make make medical practices more efficient. While there is plenty of anecdotal evidence suggesting that they do — so much that investing in portals still makes sense — it’s good to see questions about their benefits looked at with some rigor.

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

A new study by Physicians Practice magazine suggests that medical groups still aren’t getting what they want out of their EHRs, with nearly one-fifth reporting that they’re still struggling with an EHR-related drop in productivity and others still trying to optimize their system.

Physicians Practice surveyed 1,568 physicians, advanced practice providers across the U.S. as part of its 2016 Technology Survey. Nearly a third of respondents (31.9%) were in solo practice, and 34% in 2 to 5 physician practices, with percentages largely dropping as practice sizes grew larger.

Specialties represented included pediatrics (17.5%), family medicine (16.2%), OB/GYN (15.2%), psychiatry (12%), internal medicine (10.6%), surgery (2.9%), general practice (2.7%) and “other” at 22.9% (led by ophthalmology). As to business models, 63.3% of practices were independently-owned, 27.9% were part of an integrated delivery network and the remaining 8.8% were “other,” led by federally-qualified health centers.

Here’s some interesting data points from the survey, with my take:

Almost 40% of EHR users are struggling to get value out of their system: When asked what their most pressing technology problem was, 20.3% said it was optimizing use of their EHR, 18.9% a drop in productivity due to their EHR, and 12.9% a lack of interoperability between EHRs. Both EHR implementation and costs to implement and use technologies came in at 8%.

EHR rollouts are maturing, but many practices are lagging: About 59% of respondents had a fully-implemented EHR in place, with 14.5% using a system provided by a hospital or corporate parent. But 16.8% didn’t have an EHR, and 9.5% had selected an EHR (or a corporate parent had done so for them) but hadn’t fully implemented or optimized yet.

Many practices that skip EHRs don’t think they’re worth the trouble and expense: Almost 41% of respondents who don’t have a system in place said that they don’t believe it would improve patient care, 24.4% said that such systems are too expensive. A small but meaningful subset of the non-users (6.6%) said they’d “heard too many horror stories.”

Medical group EHR implementations are fairly slow, with more than one-quarter limping on for over a year: More than a third (37.2%) of practices reported that full implementation and training took up to six months, 21.2% said it took more than six months and less than a year, 12.8% said more than a year but less than 18 months, and 15.7% at more than 18 months.

Most practices haven’t seen a penny of return on their EHR investment: While just about one-quarter of respondents (25.7%) reported that they’d gotten ROI from their system, almost three-quarters (74.3%) said they had not.

Loyalty to EHR vendors is lukewarm at best: When asked how they felt about their EHR vendor, 39.7% said they were satisfied and would recommend them, but felt other vendors would be just as good. Just over 16% said they were very satisfied. Meanwhile, more than 17% were either dissatisfied and regretted their purchase or ready to switch to another system.

The big EHR switchout isn’t just for hospitals: While 62.1% of respondents said that the EHR they had in place was their first, 27.1% were on their second system, and 10.8% their third or more.

If you want to learn more, I recommend the report highly (click here to get it). But it doesn’t take a weatherman to see which way these winds are blowing. Clearly, many practices still need a hand in getting something worthwhile from their EHR, and I hope they get it.

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

We’ve all heard stories about medical practices whose productivity crashed when they brought an EMR on board, for reasons that range from workflow problems to training gaps to problems with a wonky system. But if the following study is right, there’s reason to hope that health IT will actually improve productivity over time, according to a story in Medical Practice Insider.

According to research published in journal Health Affairs, physicians with health IT on board will be able to serve about 8 percent to 15 percent more patients than they could without health IT tools. And in practices where doctors have higher levels of EMR or portal adoption, the spike could be higher, according to the research, whose team includes former national coordinator David Blumenthal.

Meanwhile, practices that adopt emerging technologies such as remote care could allow doctors to perform 5 to 10 percent of care to patients outside of the office visit, and 5 to 15 percent of care could be performed asynchronously, reports Medical Practice Insider.

Another study cited by the article, done by the National Center for Health Statistics, notes that EMRs can offer varied clinical and financial benefits, such as greater availability of patient records at the point of care. And adjunct tools like e-prescribing capabilities and the ability to retrieve lab results can save time and effort, the NCHS study concludes.

These studies are encouraging, but they don’t say much about how practices can manage the workflow problems that keep them from realizing these results. While I have little doubt that health IT can increase productivity in medical practices, it’s not going to happen quickly for most. By all means, assume your medical practice will eventually leverage health IT successfully, but it won’t happen overnight.

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Moving a medical practice from paper to an EHR is no picnic. Staff and physicians both may find the process difficult, and the changes they have to make to be threatening. But there are approaches you can take which can make the process easier. Here’s a nice triad of suggestions from EHR implementation manager Amanda Guerrero:

* Make workflow changes gradual:

Too often, medical practices assume that they can implement an EHR without making major changes to their workflow. The reality is, however, that many processes which worked fine on paper don’t work when you switch to using EHRs, Guerrero notes. So how do you go about making changes without upsetting and confusing staff and clinicians? The idea, she says, is to make sure changes happen gradually. Giving people time to adapt to changes helps a lot with staff morale. (It doesn’t hurt to explain how the changes will benefit both staff and patients, either.)

* Ask for feedback:

Bearing in mind that changes to workflow will have to be made, how do you choose which changes come first? One way, Guerrero says, is to ask the people who are using the EHR which processes are slowing things down the most. Be sure, she recommends, to include doctors, nurses, front desk and even billing staff in collecting feedback — after all, virtually any part of the practice can be affected by the EHR. Once you’ve figured out which areas are the most troublesome, arrange them in order of importance so you can take them on in the most effective manner.

* Educate patients:

Now that Meaningful Use has pushed practices into making patient health data available to them, it’s time to encourage them to use it. That being said, patients may be overwhelmed by the amount of data being presented, especially when interpreting lab results, Guerrero suggests. To reduce the impact of this change on patients, and avoid confusion, make sure you help them understand what they’re looking at and how it can help them improve their healthy, she says. And make sure let patients know you’re available to help answer questions.

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Wouldn’t it be great if you rolled your EMR and, bam, all of the problems you hoped to solve were solved, just like that? Sure, but in most cases the technical rollout will do little to solve workflow problems unless you have them analyzed in advance, according to one doctor who’s taken part in a long, slow rollout. Here’s a quick overview of his organization’s progress: see what you think.

Going live is a far cry from having truly adopted an EMR, and getting to adoption is a very long, drawn-out process, said Dr. Fred M. Kusumoto, who spoke at a recent meeting of the Heart Rhythm Society.

Dr. Kusumoto, who’s with the Mayo Clinic Jacksonville Electrophysiology and Pacing Services, conceded that EMRs can help smooth communication between systems. The thing is, he noted, integrating systems won’t happen over night. After all, the workflow of doing integration is very complex, so much so that years hardly suffice. His organization began serving as “guinea pig” for its EMR vendor in 1996 and will as of 2013, will have one database using structured data, he said.

So, the million-dollar question is this: Has all of this effort been worthwhile? Dr. Kusumoto actually didn’t say, if the CMIO article I reviewed is accurate. Interesting. But he’s clearly learned a great deal, regardless of whether his rollout works out for Mayo. Here’s some of his suggestions on how to improve returns from your maturing EMR:

* Make sure all stakeholders are involved as the EMR migration, including administrators and IT staffers.

* Bear in mind that EMR rollouts are at their most flexible in the first few years, so don’t miss your chance to get involved early.

* EMR implementations (typically) involve a scanning phase where the institution captures written records and plans for turning the records into structured data. Make sure you leave enough time to do this right.

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Here’s an EMR adoption study which interested me largely because it runs counter to what I would have predicted. The study, which surveyed physicians pre- and post- EMR implementation, found that doctors who owned a stake in their practice found their rollout to be tougher than physicians who didn’t have a stake.

I don’t know about you, but I would have assumed that the folks with more control — the owners — would have found it easier than those who have to adapt to the decisions others make. But it seems that physician-owners simply feel the pain of change more acutely.

To conduct the study, which was published last week in the Journal of the American Medical Informatics Association, researchers surveyed 156 physicians working with the Massachusetts eHealth Collaborative. The surveys included a pre-implementation questionnaire in 2005 and a post-implementation questionnaire in 2009.

Thirty-five percent of doctors who responded reported that implementation was very difficult, 54 percent said it was somewhat difficult and 12 percent not difficult. Those numbers square pretty well with what I’ve seen elsewhere. The twist here was that 38 percent of physicians with full or partial ownership stakes in their practices voted “very difficult,” versus 27 percent of non-owners. That surprised me. After all, aren’t most of the complaints coming from doctors who try to use the new systems?

According to Marshall Fleurant, MD, one of the study’s authors, the owners “probably experienced more underlying challenges associated with EHR implementation and workflow transformation” given their broader operational responsibilities.

While this study is interesting, it’s hardly the last word. Teasing out just which factors predict how doctors will react to EMR implementation, much less what it takes to support them, is still a new science. But it never hurts to bear in mind that physicians making critical management decisions get support, too.

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

While Mr. Steele’s comments may not be wildly original, I always like to see discussions of tricky issues like usability boiled down to a few key points, and he’s done a good job here. His arguments, with my commentary:

* Feedback from physicians and other providers should drive EMR usability improvements.

Of course — shouldn’t the software clinicians work every day with to improve health and save lives be adapted to fit the needs of those clinicians? You can’t offer complete freedom when you’re collecting structured data, but clinicians should be able to bend and stretch things as much as possible.

That of course, begs the question of what’s driving usability models right now, doesn’t it? Certainly, EMR vendors care what clinicians think, but my guess is that the development roadmap has to come first far too often.

Here, let’s pretend I’ve inserted a lengthy rant as to how enterprise software companies in general just don’t connect well with their customers — something that became painfully obvious to me when I worked for one several years ago. Suffice it to say that I doubt clinicians are as involved in vendors’ UI dev, much less feature set specs, as often as they should be.

* Usability measures should embrace not only primary care, but also specialists.

Again, this seems fairly obvious to me, but seemingly, not to federal officials, who, according to Steele, treated specialty needs as an “afterthought” when creating Meaningful Use standards.

In my opinion, it’s become fairly clear that specialty-facing systems are important, and that regulators should address such systems on their own terms. I’ve seen no sign that they’ve developed plans to do so as of yet, though. (Anyone know more than I do on this?)

* Usability shouldn’t be legislated.

For at least a couple of years, there’s been talk of the FDA’s stepping in and imposing usability rules on EMRs; observers say the rules would be akin to those they already do on medical devices and supporting software. (See more on this issue from medical device connectivity expert Tim Gee here.)

Steele, for his part, thinks such regulations would cause problems. Imposing governmental standards on EHR interface “will inevitably accommodate only a narrow range of users, leaving those with varying preferences and workflows without software to satisfy their usability requirements,” he argues.

I’d like to see Steele get his way on the first two suggestions. If EMR interfaces are driven by clinicians and take specialists into account, it’s far less likely that the government will feel obliged to impose itself upon the marketplace.

But if the industry doesn’t do a better job of partnering with clinicians, expect to see the FDA or other agencies step in. Regulators may decide that if the industry can’t produce usable EMRs on its own, predictable, rulebound ones will do.

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

As any reader of this blog would know, there may be more EMR rankings out there than there are EMRs themselves. Of course, some lists are taken more seriously than others — KLAS comes to mind — but these days, with the money flowing, virtually everyone who can make a PDF is dipping an oar into the EMR ranking game.

The following list, from a a site called Business-Software.com, is particularly cute in that it would appear to be entirely bought and paid for by vendors — there’s nary a critical analysis to be found in the paper. (Most of the lists I’ve seen at least pretend to be neutral.)

That being said, I still thought it might stimulate conversation among us to share the list. I’d love to hear whether you think Business-Software.com has provided any value here, and whether you’ve had particularly good (or bad) experiences with listed EMR sellers.

Here’s Business-Software.com’s list, seemingly in no particular order. Where available there’s a link to get a demo/price quote from the vendors on the list courtesy of Medical Software Advice.

* AdvancedMD: Provides Web-based practice management, medical billing and scheduling software as well as an EMR. Includes a patient portal, e-prescribing and mobile access option.

* Celerity Solutions Group: Provides EHR conversion and systems integration solutions to both large and small medical practices.

* NextGen Healthcare: Offers a very wide range of products, including EHRs for physicians, hospitals, health centers and healthcare providers, as well as practice management and financial management systems, HIE and patient portal options.

* meridianEMR: EMR focused specifically on urology specialists, as well as a product aimed at general surgery.

What bothers me about this list, by the by, is that while it’s almost certainly a series of advertisements, that’s not marked anywhere.

While physicians aren’t dummies by any means, my guess is that some might get sucked in by any list that says “top” in it if they’re feeling desperate enough. Here’s hoping physicians catch on to the bias here.

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

According to an estimate I heard recently, if a doctor’s productivity drops as little as 3 percent to 5 percent the first year after installing an EMR, they’ve already lost more than the $40,000 they can make from Meaningful Use incentives. And while there will be exceptions, I can’t help but think that most practices will fall into that category.

After all, EMRs aren’t just new software. They represent a new way of thinking about workflow and the practice of medicine generally. While that may ultimately be a good thing, over the short term it’s likely that even tech-friendly doctors will need some time to adjust.

So, why are medical practices worked up over MU compliance? Certainly, it doesn’t hurt to stay on CMS’s good side, and the $40K sounds sweet at the outset. Also, I’m sure some practices genuinely believe that EMRs can improve the quality of care they provide — and see the incentives as an added benefit.

That being said, I’d argue that the hunger for Meaningful Use incentives puts far too much pressure on doctors, pushing them to make EMR buying decisions before they’re prepared. Choosing a piece of enterprise software is tough enough even in hospitals with veteran IT teams in place; for smaller practices, which may not have even a single tech on staff, it’s even riskier.

If I ruled the world (OK, even HHS), I’d spend more on bringing vendor selection, training and change management support to doctors, and focus less on payoffs. But as things stand, CMS seems largely focused on handing out the cash. All I can do is encourage doctors not to be blinded by short-term gain, and phase in EMRs at their own pace. For most practices, I’d argue, that will work much better over the long run.

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

The following questions have been bothering me, and I don’t have answers. Maybe readers will be able to fill me in.

As far as I know, pharmaceutical companies haven’t been subsidizing or providing EMR software to medical practices, though I can’t imagine a better opportunity to a) form even closer ties with medical practices and b) get their message in front of physicians every day.

Attorneys, if you’re reading these, feel free to chime in and let me know if I’m not up to date; I realize laws governing donations to physicians are a moving target. But assuming it’s still legal, I can’t see why pharmas haven’t jumped all over this idea.

I don’t know enough about pharma marketing costs to hazard a guess on what this strategy would generate financially, but I can only imagine it would be a winner.

Another stumper: why aren’t health plans investing in EMRs for their physicians on a large scale?

Not only would EMRs potentially improve efficiency and lower costs, they’d also give the plans an opportunity to build in real-time claims processing. That’s a huge win for both doctors and plans. From what I’ve read, health plans could save billions in paper transaction costs alone if they could use EMRs as a platform to connect processing directly.

As I see it, both of these industries have even better reasons to push EMR adoption than hospitals. Sure, hospitals need to connect with doctors, build loyalty and coordinate care, but the financial upside seems much larger — and more measurable — for pharmas and health plans.